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Adnexal (pelvic) masses & Ovarian cysts

Pelvic masses and ovarian cysts are very common in females of all ages. One study found ovarian masses (lesions) in one of every 12 women who were completely symptom free at the time of their ultrasound.

In a study examining 656 women with a persistent adnexal mass, ovarian cancer was found in 122 patients and ovarian borderline tumours were found in 19 women. The remainder of the women were diagnosed with benign tumours of the ovary or the fallopian tube (Guerriero et al, 2001).

While benign ovarian masses are harmless, malignant masses (ovarian cancers) need to be recognised so that we can treat them accordingly and early. Unfortunately, no 100%-reliable tool is available to distinguish between benign and cancerous masses.

We use the patient’s age, features on medical imaging (ultrasound) and tumour markers (blood) to estimate the risk of cancer.

  • In patients with a very low risk of cancer, we often recommend to monitor the cyst in 2 or 3 months periods.
  • Patients who develop symptoms (pain) but otherwise have a low risk of malignancy, surgery will be offered. Surgery can be with a general gynaecologist or a gynaecological oncologist.
  • Patients with a moderate or high risk of malignancy are offered expedite surgery and those patients may benefit from surgery through a gynaecological oncologist. Surgery with a gynaecological oncologist will save the patient an unnecessary second surgical procedure in case a malignancy is found.
  • Patients with a personal history of breast cancer or patients with a family history of breast, ovarian, pancreatic and other cancers may carry genes predisposing them to ovarian cancer.  

Premenopausal women:

Pelvic masses can arise from the ovary but also from other structures in the pelvis such as the fallopian tube, the uterus, the bowel, appendix, or the kidney.

Adnexal masses potentially can be: 

  • Functional cysts including polycystic ovary syndrome
  • Pregnancy-related (ectopic pregnancy)
  • Inflammation/infection (Pelvic inflammatory disease, tubo-ovarian abscess)
  • Endometriosis (endometrioma)
  • Leiomyoma (arising from the uterus)
  • True neoplasms (benign or malignant/cancerous): e.g. Ovarian cancer
  • Cancers arising from somewhere else but spread to the ovary

Pelvic masses and ovarian cysts require surgical exploration if they are either considered as suspicious or if they cause symptoms (pain). Otherwise ovarian cysts can be just monitored. 


Postmenopausal women:

The likelihood that a pelvic mass is cancerous increases with age. All suspicious ovarian masses in menopausal women (except simple ovarian cysts) should be regarded as cancer unless proven otherwise. 

Ovarian carcinoma affects one in 80 women in Australia and advanced age is the biggest single risk factor. There are more than 20 types of ovarian cancer. Ultrasound, CT scan and tumour markers may point to the high probability of ovarian cancer but some types of ovarian cancer are extremely difficult to diagnose prior to surgery. More about ovarian cancer here.

Functional ovarian cysts are still common in perimenopausal women. At the beginning of menopause, progesterone is the first hormone to decrease, which may lead to a relative oversupply of oestrogens. High oestrogen levels may cause ovarian cysts. Treatment with progestins may reverse those functional cysts.


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